Dental Forensics

A briefing designed to help augment local dental readiness training requirements

Dental Forensics
 Branch of science that applies dental knowledge in civil and criminal investigations  Internationally described as Forensic Odontology  Includes not only dental identification but also involves mass disaster procedural management

Identification Methods
     Visual Finger/foot prints Radiological DNA Dental

Visual
 May not be possible due to disfigurement or fragmentation due to disaster trauma  Least reliable due to emotional stress and subjective assessment required of family member

Finger/foot prints
 Severe fires with disasters may eliminate post-mortem samples  Civil fingerprint data has dramatically reduced  Latent finger prints from victim personal property can be obtained, but difficult & time consuming

Radiological
 Useful only if victim has ante mortem medical radiographs

DNA
 Becoming standard in military  Civilian sector lagging behind  Different protocols for identification
 Has not been tested yet in mass disaster situation  Legal precedents?  Expensive!

Dental Identification
 Unique
 No two individuals have identical dentitions  Dental care rendered is often unique  Identification can sometimes be made from one tooth

 Durable
 Teeth most durable part of human body  Remains after decomposition, fire, or trauma

Mass Disaster Management

 Mass disasters can occur at any location!
 Every facility needs a written plan  Plan identifies
 Team members  Plan for team activation  Physical & alternative facilities used  Instruments & supplies (should be ready)

Mass Disaster Management

 Identification areas must be isolated away from outside influences  Confusion will attempt to rule  Follow the chain of command  No information released without Med Group Commanders approval  Do not be afraid to ask for outside qualified help!

Human remains identification

 Begins at disaster site
 Security cordon established  Human remains found and tagged and staked with numbers  Locations of remains charted on map of disaster area  Photographs taken of area  Removal of remains in bags is next accomplished

Human remains identification

 Disaster site preparation
 Body parts and personal effects are attempted to be placed in one bag  Body part intermingling of multiple victim accidents will add confusion to identification  Body bags are then transported to storage or disaster identification center

Human remains identification

 Major task that should begin early after disaster is the establishment of probable victim identification so that antemortem records may be obtained as quick as possible
 Manifest lists  Missing person reports  Eyewitnesses

Identification center organization

Center Team Chief
     Sections/Teams Registrar Communications Public Affairs Security

Sections/teams
         In-processing Photography Fingerprints Personal effects Pathology/Lab Anthropology Forensic Dentistry Mortuary Storage/Shipping

Identification center flow diagram

Initial processing Fingerprints & photography Radiology & personal effects

Laboratory

Forensic Dentistry

Pathology & Anthropology

Mortuary Processing

Storage

Shipping

Forensic Dental Organization

Identification Center Chief Forensic Dentistry Chief

Antemortem Dental Record Section

Postmortem Dental Exam & Radiology Section

Postmortem record & comparison section

Forensic Dental Organization

 Forensic Dental Chief  Antemortem records section  Postmortem exam & radiology section  Postmortem record comparison section

Forensics Dental Chief

 Manager, coordinator, facilitator & spokesperson for dental section  Responsible to ID center chief  Responsible for smooth data flow both within own section and between ID center sections

Antemortem Records Section

 Determine who was possibly in disaster  Locate & procure antemortem records, arrange for delivery to disaster center  Develop composite antemortem record for each potential victim from evidence supplied

Dental Charting
 Entire team must be consistent  Charting standards should be provided to every member for reference  Universal numbering system preferred
 Simple in nature  Easily computerized

ANTE MORTEM DENTAL RECORD

AF FORM 1802

Antemortem charting

Antemortem charting

CAPMI
 Computer Assisted Post Mortem Identification
 Facilitates rapid processing of possible matches  Confirmation and final positive identification is still a HUMAN process

Antemortem Records Section

 Quantity, quality, & varied documentation major obstacle
 Reduce antemortem dental evidence to single composite record  Civilian dental officer records not uniform or informative

 Two members of antemortem staff should review composite antemortem record as a QA check

Antemortem Records Section

 Composite antemortem record with supporting evidence
    Placed in large manila folder Identified with name Arranged alphabetically Kept in secure area

Postmortem Identification
 Nature of disaster determines amount of time involved with postmortem dental examination  Depending upon condition of victim, usually involves
 Preparation/dissection & cleansing  Radiographs  Exam & charting

Postmortem Identification
 Facial dissection
 Required with rigor mortis  Allows exposure of oral cavity for exam and radiographs  Removes all soft tissue surrounding oral cavity  Does not remove maxilla or mandible from the body

Postmortem Identification
 Facial dissection
 Perioral incision & tissue removal  Mandible sectioned & submylohyoid incisions  Separate ramus and incise pterygoids  Floor of mouth incision connecting all external incisions

Facial Dissection
 Perioral incision
 Removes extra oral tissue over teeth

Facial Dissection
 Perio oral incision
 Will allow exposure of facial surfaces of teeth and posterior surface of mandible

Facial Dissection
 Mandible sectioned & submentalmylohyoid incisions

Facial Dissection
 Separate ramus and incise pterygoid musculature
 Frees mandible from rigor mortis musculature tetani

Facial Dissection
 Floor of mouth incision
 Connects to all external incisions  Frees mandible for manipulation to facilitate exam and radiographs

Post mortem charting

 Process begins with tooth #1
 Examiner makes statement of findings  Visually confirmed by recorder  Recorder charts the findings which is visually confirmed by all

 Redundancy involved provides necessary quality control

Post mortem charting

 Factors to be considered/recorded
 Restorations  Missing teeth
 Antemortem or due to trauma

 Prosthetic appliances
 Note any unique features

 Pathology/unique anatomy  Age estimate, possible gender, or racial group

Post mortem charting

 Accomplished on AF Form 1801  Mirror image of Antemortem Dental Record ( AF Form 1802)
 Allows side-by-side comparison

 Same charting and CAPMI symbols as antemortem record

POST MORTEM DENTAL RECORD

AF FORM 1801

Post mortem radiographs

 Portable 50 kvp unit adequate  Practice safe shielding techniques  Automated processor
 Produces dry films ready for mounting

 Only process one case at a time  4 x 4 gauze packs to stabilize films during exposure

Post mortem radiographs

 Use double film packs  Reduce exposure time for skeletinized remains  Use bisecting angle technique  Increase tubehead-film distance
 Generalized view desired  More detailed & specific films may be taken if necessary

Post mortem radiographs

 ARE A MUST!
 Provides objective legal evidence
 Dental treatment and anatomy unique  Ante/post mortem comparison invaluable  Unique alveolar/dental anatomy can establish identification if no restorations exist  ID can be made on as little as one fragment or one tooth if unique anatomy or restoration present

Post mortem dental records & comparison

 Compares ante/post mortem records for possible matches  Once significant comparison point is reached, radiographs of respective records can be reviewed to help establish identity.  Large disasters need computer processing (CAPMI) of information

Post mortem dental records & comparison

 Computer processing
 Jonestown-Guyana (913 Fatalities)
 Comparison of only one antemortem record against 913 postmortem records (assuming 2 min/record) would take over 30 hours!

 Computer can provide lists of records with similar dental data

 Dentists must still make positive identification!

Post mortem dental records & comparison

 Once positive dental ID is made, proper documentation is accomplished  All of victims documents are placed together and secured
 Copies would be nice

 All IDs are notified through dental chief to ID Center Chief  DO NOT RELEASE INFORMATION OUTSIDE OF THIS CHAIN

References
 Mass Disaster Management. William M Morlang. Armed Forces Institute of Pathology 1984

If any questions . . .
 About content of this lecture
 Consultant in Oral & Maxillofacial Pathology, 59 Dental Squadron (WHMC), DSN 554-7633

 About the format of this lecture

 Lt Col Howard Roberts, USAF Dental Investigation Service, DSN 792-7679